| Summary: | 碩士 === 國立臺中教育大學 === 諮商與應用心理學系碩士班 === 100 === The purpose of the study was to understand the loss experience and free-writing experience on hospice nurses by means of qualitative semi-structure in-depth interview. Three hospice nurses were recruited through connections to share their loss experience in caring for the end-of-life care. Later on, the 20-minute free-writing activity was administered at least three times a week over a 3-week period. Then, the in-depth interview was conducted to explore the free-writing experience of participants. Hermeneutic phenomenology approach was applied to analyze the collected data. The findings of this study include:
1. Loss experience of hospice nurses
1.1. Nurse-patient perspective: Loss may occur when hospice nurses are interested in or willing to understand patients or their family. As they believe that there is a certain kind of connections between them and an opportunity to get along with one another for some time, nurses are concerned about the process and ending of patients in their last hours. As a result, they felt loss when patients passed away.
1.2. Professional role and mission perspective: Situations unfavorable to good death occurred in mission include:
(1) Professional competence and experience inadequacy
Nurses are unable to notice or sense the patient’s condition, nor can they know what assistance to be offered or answer transcendental questions about life.
(2) Six situations arising from patient characteristics and the terminal situation:
a. psychological preparedness for the inevitable death of patients;
b. limited time remaining and no chance for retry of patients;
c. incapability to help patients to relief pain;
d. uncertainties or events out of reasonable human control;
e. inability to help patients according to their wish from inability to understand patient needs; and
f. inability to fulfill the last wishes of patients.
(3) Conflicts in treatment opinion between nurses and patient family/medical team: including emergency care for dying patients, inability to relief the pain of patients with medication, and the suggestions being accepted.
(4) Loss from concern about the needs of patients and inability to help them fulfill such needs.
2. Effect of loss experience on hospice nurses
2.1. Four lessons learned from experience: (1) be brave to talk about death-related issues and affirm the importance of accompaniment before terminal stage; (2) realize the dying and impermanence of lives and patients as mentors of life; (3) enrich life experience and improve care competence; and (4) turn negative experience into positive strength.
2.2. Two behavioral changes in caring patients: (1) be more careful and dedicated in caring patients and prevent regrets; and (2) understand personal limitations and do the best according to circumstances and capacity.
2.3. Three negative effects: (1) poor professional performance; (2) psychological burdens and pressure; and (3) poor life quality.
3. Methods for handling the loss of hospice nurses
3.1. Loss and performance are influenced by expertise and culture: the higher the seniority of participants, the less the feeling of loss.
3.2. Handling of Loss
(1) At the rise of emotions, block the emotion and distract from the subject matter. When loss is expected, adjust oneself and grasp time to finish things at hand.
(2) When loss bursts out, seek support and help from peers, friends and relatives, patients and their family, and religion; improve professional skills and confidence from professional training, discussions and healing courses; relieve mood by relaxing oneself and resting the moods, in order to regain strength for work.
4. Experience in free-writing and free-writing loss by hospice nurses
4.1. Free writing can be acquired within a short time, and the spontaneous reaction in writing is true feedback. The difficulty in writing can be resolved from practice and conscious relaxation and control. After writing, hospice nurses can learn more about the event from the handwriting and diction.
4.2. Six experiences from free-writing and free-writing about loss:
(1) Writing allows the participants to speak out things that had no time to speak and release the unexpressed emotions, in order to release the mood and put the burdens down.
(2) Writing allows the participants to get closer to the true thoughts in mind and temporarily put down the cognition and duty of their professional roles to realize emotions more attentively and face loss unperturbedly.
(3) Writing reflects the present state and what people care about in the past. The contents of writing may cross time and space according to the writer’s mind. Themes will twist and turn, lose focus or twine together. In a time, they form a cross reference or contrast, and in another time, they are merely narrations or descriptions, thus allowing people to understand the same event from different viewpoints.
(4) Writing allows people to re-experience the events depicted, face the effect of loss, and tackle and transform loss.
(5) Writing allows people to sort out and integrate existing information, in order to clarify issues and extricate from an emotionally difficult situation.
(6) Writing allows people to record and recognize experience, face the progress of loss management, and get meaningful interpretation and different insight through the process of restructuring.
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